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47 Cards in this Set

  • Front
  • Back
Aqueous fluid
absorbed by the visceral pleural capillaries
Protein phase
absorbed by the parietal pleural lymphatics
-more than 1/2 protein
-more than 6/10 lactate dehydrogenase
-formed by active abnormal cellular process
Causes of exudate
-infections: TB, fungus, penuemonia
-drug reaction
passive movement of fluid resulting from 3 physiologic phenomina:
-increased hydrostatic pressure
-decreased plasma oncotic pressure
-increased neg. intrapleural pressure
causes of transudate
-Nephrotic syndrome
-acute atelectasis
a form of exudate
-fluid is turbid or purulent due to infx in the pleural space itself
-gross blood in the pleural space
-usually due to chest trauma
milky appearance due to cholesterol complexes
-should be centrifuged: if top is clear, its empyema, not its chylothorax
small effusions
usually asymptomatic
Large effusions
-decreased breath sounds and femitus
-dullness to percussion
-massive: may push the trachea to opposite side
X-Ray findings
-thickening of interlobal and /or interlobular lung fissures
-loculate fluid
-crescentic line or meniscus
Transudate: treatment
treat underlying condition
Exudate treatment
tube thoracostomy
hemorthorax treatment
usually one or more chest tubes
the pathologic expansion of the bronchi or bronchioles resulting from chronic necrotizing infections caused by various conditions that destroy the bronchiole smooth muscle and elastic tissue
Bronchiolectasis: S/S
-expectoration of copious purulent, sometimes fetid sputum
-flecks of blood, if not frank hemoptysis
causes of bronchiectasis
-foreign body
-mucus impaction
-cystic fibrosis
-HIV / or other immunodef.
pathogeneis of bronchiectasis
obstruction and chronic infx
-usually effects lower lobes
-mixed flora
bronchiectasis: labs
thin section CT shows dilated airways
X-Ray: bronchiectasis
-shows increased bronchovascular markings from:
-peribronchial fibrosis
clinical sign
finger clubbing
Treatment: bronchiectasis
-resp. therapy
-exercise & breathing ex.
-pursed lip breathing
-O2 therapy
-avoid smoking/sedatives/antitussives
Primary (ideopathic) Pulmonary HTN
-rare, mostly young women
-progressive dyspnea: death in 2-8 years
-unknown cause, see diffuse narrowing of pulomonary arterioles
Secondary pulmonary HTN
-vasoconstriction: chronic dyspnea
-loss of pulmonary vessels
-vascular obstruction
-increased pulm. venous pressure
-increased blood viscosity
Loss of pulmonary vessels: causes
-pulmonary fibrosis
-autoimmune disease (RA,SLE)
Vascular obstruction
-pulmonar emboli
-foreign bodies
increased pulmonary venous pressure
-increased mitral stenosis
-constrictive pericarditis
increased blood viscosity
S/S pulmonary HTN
-chest pain
-syncope on exertion
Pulmonary HTN: lab findings
-polycythemia in many cases
-ECG shows
-R atrial enlargement
-R ventricular strain
-V/Q scan: may show defects
-PFT's no routine changes
Pulmonary HTN: Treatment
-NO real effective treatment
-periodic phlebotomy if polycythema and hematocrit >60%
seperation of the visceral and parietal pleurae by volume of air
Primary spontaneous PTX
occurs in the absence of underlying lung disease
Secondary Spontaneous PTX
occurs in complications of lung disease
Traumatic PTX
-blunt or penetrating trauma
-iatrogenic causes
-subclavian or internal jugular vein catheterization
-percutaneous lung Bx
-pulm. barotrauma from mech. overventilation
Tension PTX
-air enters thorax during inspiration but does not exit on expiration
-positive interpleural pressure> ambient pressure
-may be due to trauma, CPR or mechanical ventilation
Primary PTX
-often tall, thin boys
-thought due to rupture of subpleural apical blebs due to high pleural pressure
-smoking increases risk
Secondary PTX
-associated with other lung diseases:
Catamenial PTX (secondary)
-assoc. with onset of menses +/- 3 days
-assoc. with intrathoracic endometriosis
PTX general S/S
-chest pain, minimal to severe on affected side
-perhaps mild tachycardia
-if large:
-breath sounds, fremitus decreased
-asymmetric chest expansion
-hyperresonance or tympany on chest percussion
Diagnosis of PTX:
suspect if:
-severe dyspnea & marked tachycardia
-tracheal or mediastinal shift
-systemic hypotension
-widespread percussion hyperresonance or tympany
-ABGs show hypoxemia & acute resp. alkalosis
-viscereal pleural line = defninitive dx
-may see pleural effusion, blunting of costophrenic angle
-may see shift of tracheal air column TOWARD a NL PTX
-may see shift of tracheal column & mediastinum AWAY from a tension PTX
Possible complications of PTX
-subcutaneous emphysema
-pneumonmediastenum on CXR
PTX treatment: Small (<15% of hemithorax)
-may only observe
-O2 supplementation may increase rate of air reabsorption
-serial CXRs q24 hr to follow
PTX treatment: Large
-admit to hospital
-thoracostomy with underwater seal drainage and suction until lung expands on serial CXR